American Thoracic Society

PATIENT EDUCATION | INFORMATION SERIES

Chest Tube Thoracostomy

Chest tube thoracostomy (tho¯r-e-’kas-te-me¯), commonly referred
to as “putting in a chest tube”, is a procedure that is done to drain fluid,
Normal Collapsed
blood, or air from the space around the lungs. This procedure may be Lung Lung
done when a patient has a disease, such as pneumonia or cancer, that
causes extra fluid to build up in the space around the lungs (called a
pleural effusion). A chest tube may also be needed when a patient has
had a severe injury to the chest wall or surgery that causes bleeding
around the lungs (called a hemothorax). Sometimes, a patient’s lung
Pleural Air or fluid in
can be accidentally punctured, allowing air to gather outside the lung, space the pleural space
causing its collapse (called a pneumothorax).

Chest tube thoracostomy involves placing a hollow
plastic tube between the ribs and into the chest to drain
fluid or air from around the lungs. The tube is often
hooked up to a suction machine to help with drainage.
CLIP AND COPY
of fluid to build up around the lung. Doctors usually
drain the fluid with a needle. If the fluid keeps coming
back, however, it may be necessary to insert a chest
tube to first drain the fluid, and then deliver special

The tube remains in the chest until all or most of the
air or fluid has drained out, usually within a few days.
Occasionally special medicines are given through a
chest tube when the fluid or air does not resolve within
a few days.
Why Do I Need a Chest Tube?
Common reasons why a chest tube is needed include:
■ Collapsed lung (pneumothorax)—This occurs when
air has built up in the area around the lungs (the
pleural space) from a leak in the lung. This leak may
be the result of lung disease. It can also occur as a
complication of certain medical procedures. Chest
tubes are often needed to remove air from around
the lung. Failure to remove such air can be life-
threatening if there is a lot of air or a continued leak.
Removing the air allows the lung to re-expand and
seal the leak.
■ Infection—An infection can sometimes cause fluid to
build up around the lung and may be necessary to
insert a chest tube to remove the fluid. Getting the
fluid out can at times help clear the infection faster.
A culture can also be done on the fluid to try to figure
out what type of infection is present.
■ Cancer—Some cancers spread to the lung or pleura
(lining of the lung). This can cause large amounts
medicines into the chest that reduce the likelihood of
the fluid building up again.
■ Comfort—A large buildup of fluid or air in the chest
can make it difficult to breathe. Removing some of
the fluid or air may decrease discomfort and make it
easier for the person to breathe.
■ Chest Surgery—Sometimes a chest tube is left in place
after surgery. The surgeon can usually tell you if it will
be needed and how long it may need to stay in.
Risks of Chest Tube Insertion:
Below are listed some risks of chest tube thoracostomy.
It should be noted that the risk of serious complications
(bleeding and infection) is uncommon (usually less than
5% of cases). Your healthcare provider will explain the
risks and how likely they may be for you when you give
consent for the procedure.
■ Pain during placement—Discomfort often occurs as
the chest tube is inserted. A local numbing medicine
is used to help reduce any pain or discomfort. The
discomfort usually decreases once the tube is in place.
■ Bleeding—A blood vessel in the skin or chest wall may
be accidentally nicked as the tube is being placed.
Bleeding is usually minor and stops on its own. Rarely,
bleeding can occur into or around the lung and may

Am J Respir Crit Care Med Vol. 170, P3-P4, 2004

Online version updated February 2020
ATS Patient Education Series © 2004 American Thoracic Society
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PATIENT EDUCATION | INFORMATION SERIES
require surgery. Usually bleeding can just be watched
with the chest tube in place.
■ Infection—Bacteria can enter around the tube and
cause an infection around the lung. The longer the
chest tube stays in the chest, the greater the risk for
infection. The risk of infection is decreased by special
care in bandaging the skin at the point where the tube
goes into the chest.
Chest tube insertion
Fluid or air in the chest that needs to be drained is
identified using chest imaging such as chest X-ray, chest
ultrasound, or chest CT scan. If the X-ray shows a need
for a chest tube to drain fluid or air, the procedure is
likely to be done by a surgeon, a pulmonary/critical care
physician or an interventional radiologist.
Often an adult or older child remains awake when
a chest tube is inserted, except when it in placed in
the operating room during an open chest procedure.
Sometimes a person, particularly a younger child,
is given a small amount of medicine (a sedative)
that causes sleepiness before a chest tube is
inserted. The skin will be thoroughly cleaned. A local
anesthetic (numbing) medication will be injected
into the skin and in the tissue along the path
between the ribs that the tube will follow. A cut
(incision) from ¾ inch to 1½ inches long, between
the ribs (the exact location depends on what is being
drained and its location in the lungs). The chest tube
is inserted and will be stitched into place to prevent
it from slipping out. An airtight sterile dressing
bandage is placed over the insertion site. The chest
tube will be connected to a drainage collection
device (usually a clear plastic container that rests
on the floor). Often it is attached to suction to help
draw out the air or fluid.
What happens when the chest tube is in?
Most people will need to stay in the hospital the entire
time the chest tube is in. You will be checked often
for possible air leaks, plugging of the tube, and any
breathing problems you may be having. Usually, you will
be able to breathe more comfortably with the tube in
place. Sometimes pain around the area where the tube
enters the chest may cause you to take more shallow
breaths. The nurse or doctor will tell you how much
you can move around with the chest tube in place. Less
and less fluid drainage in the collection device often
means your lungs are improving. Sometimes the tube
is clamped and left in place to make sure no fluid or air
comes back before it is pulled out.
American Thoracic Society
Will there be any pain or possible complications
when the chest tube is removed?
When the doctor determines that you no longer
need the chest tube, it will be removed. Usually it can
be taken out right at your bedside. There rarely is a
need for sedation medication. You will be told how to
breathe as the tube is being pulled. A secure bandage
will be put in place. You will be told when the bandage
can be removed. Often, a follow-up chest X-ray will be
done to make sure that fluid or air haven’t come back.
Generally there are no complications from the chest
tube once it has been removed. You will only have a
small scar.
Source: Manthous, CA, Tobin, MJ, A Primer on Critical Care for
Patients and Their Families, ATS Website: http://www.thoracic.
org/clinical/critical-care/patient-information/index.php
Reviewed and revised August 2012 by Kevin Wilson, MD and
Colin Cooke, MD.
Reviewers: Marianna Sockrider MD, DrPH, Glen Chung MD
R Action Steps
You/your loved one has or is scheduled to have a
chest tube inserted to remove excess fluid, blood or
air from the area around their lungs.
✔ Talk with the healthcare provider about the use
of numbing medicine or medicine that causes
sleepiness (sedation) before the procedure.
✔ Talk to your doctor or nurse about any pain or
shortness of breath you may have after the chest
tube is in place.
✔ Have your nurse tell you what to watch out for
with the chest tube for any possible problems.
Healthcare Provider’s Contact Number:
For More Information
American Thoracic Society:
• www.thoracic.org
U.S. National Library of Medicine—Medline Plus
• https://medlineplus.gov/ency/article/002947.htm
This information is a public service of the American Thoracic Society.
The content is for educational purposes only. It should not be used as a
substitute for the medical advice of one’s healthcare provider.
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